Eating Disorders: Bulimia nervosa - Causes and risk factors

Bulimia nervosa is defined as a medical condition of  consuming a large amount of food in a short amount of time or one setting (binge eating), followed by self induced vomiting, taking a laxative or diuretic and/or excessive exercise, etc. to compensate for the binge. Bulimia nervosa also effects almost 90% of female. Unlike anorexia nervosa, people suffering from bulimia nervosa are usually normal or slightly over weight.
Causes and risk factors
A. Causes
The causes of bulimia vervosa is unknown but in  the study to examine the beliefs of women concerning causes and risk factors for eating-disordered behaviour, showed that having low self-esteem' was considered very likely to be a cause of BN by 75.0% of respondents, and the most likely cause by 40.5% of respondents. Other factors perceived as significant were 'problems from childhood', 'portrayal of women in the media', 'being overweight as a child or adolescent' and 'day-to-day problems', while genetic factors and pre-existing psychological problems were perceived to be of minor significance. Most respondents believed that women aged under 25 years were at greatest risk of having or developing BN(9).

B. Risk factors
1. Gender
It you are female, you are at 90% higher risk to develop bulimia nervosa.
2. Age 
In both anorexia nervosa and bulimia nervosa, age at onset showed a significant decrease according to year of birth(10)
3.  Social pressure
The fear of become fat due to wrongly influent in the western society where attractiveness is equal to thinness
4. Family history
If one the member of your direct family has bulimia nervosa, you are at increased risk to have that disease as well.
5. Migraine
Dr. D'Andrea G, and the research team at the Biochemistry Laboratory for the Study of Primary Headaches and Neurological Diseases, Research and Innovation S.p.A suggest that migraine may constitute a risk factor for the occurrence of ED in young females. This hypothesis is supported by the onset of migraine attacks that initiated, in the majority of the patients, before the occurrence of ED symptoms, in the study of Is migraine a risk factor for the occurrence of eating disorders? Prevalence and biochemical evidences(11).

6. Obstetric complications
Researchers found that several complications, such as maternal anemia (P = .03), diabetes mellitus (P = .04), preeclampsia (P = .02), placental infarction (P = .001), neonatal cardiac problems (P = .007), and hyporeactivity (P = .03), were significant independent predictors of the development of anorexia nervosa. The risk of developing anorexia nervosa increased with the total number of obstetric complications, the obstetric complications significantly associated with bulimia nervosa were the following: placental infarction (P = .10), neonatal hyporeactivity (P = .005), early eating difficulties (P = .02), and a low birth weight for gestational age (P = .009). Being shorter for gestational age significantly differentiated subjects with bulimia nervosa from both those with anorexia nervosa (P = .04) and control subjects (P = .05)(12).

7. DRD4 gene
Although there is no evidence of the direct association between DRD4 gene and bulimia nervosa, researchers suggested that its variants are associated with a history of childhood ADHD in BN probands. This may have relevance for the understanding, prevention, and treatment of BN that evolves in the context of childhood ADHD(12a).

8. Other risk factors includes
Low self-esteem', 'problems from childhood', 'portrayal of women in the media', 'being overweight as a child or adolescent' and 'day-to-day problems', while genetic factors and pre-existing psychological problems(13) 

9. Etc.
 
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Sources
(9) http://www.ncbi.nlm.nih.gov/pubmed/15209840
(10) http://www.ncbi.nlm.nih.gov/pubmed/20141711
(11) http://www.ncbi.nlm.nih.gov/pubmed/22644175
(12) http://www.ncbi.nlm.nih.gov/pubmed/16389201
(12a) http://www.ncbi.nlm.nih.gov/pubmed/22271608 
(13) http://www.ncbi.nlm.nih.gov/pubmed/15209840